Critical analysis of the intraoperative parathyroid hormone decrease during parathyroidectomy for secondary and tertiary hyperparathyroidism

Silveira, André Albuquerque; Brescia, Marília D’Elboux Guimarães; Nascimento, Climério Pereira; Arap, S; Montenegro, Fábio Luiz de Menezes

doi:10.1016/j.surg.2020.06.043

Cited by 7 publications

(10 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Silveirae et al in their study found Para th secondary hyperparathyroidism 11 . The authors also discussed that in patients diagnosed with renal hyperthyroidism who underwent Para thyroidectomy, using parathyroid hormone during the procedure helped to assume an earlier therapeutic outcome which was both specific and sensitive.…”

Section: Discussionmentioning

confidence: 82%

“…Patients were classified as primary hyperparathyroidism when the MIBI scan detected an adenoma with clinical features ofhypercalcemia and increased PTH whereas, patients were diagnosed with secondary hyperparathyroidism if patient presented with renal failure, persistently high levels ofPTH, as well as hypocalcemia. Secondary hyperparathyroidism was defined as persistently high PTH level (normal PTH =65 pg/ml) 11 .…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Early Bone Pain Relief a Reliable Indicator of Successful Para Thyroidectomy - A Comparative Prospective Study

Haider¹,

Ghansham²,

Mahmood³

et al. 2023

PJMHS

View full text Add to dashboard Cite

Aim: To evaluate early bone pain relief as anindicatorof successful Para thyroidectomy in hyperparathyroidism. Methodology: A prospective, comparative study was conducted at the Department of Surgery, Jinnah Postgraduate Medical Center, between March 2022 and August 2022. All patients with symptoms of hyperparathyroidism, confirmed with increased intact parathyroid hormone and elevated levels of calcium onpresentation were included in the study. Patients were classified as primaryhyperparathyroidism when the MIBI scan detected an adenoma with clinical features ofhypercalcemia and increased PTH whereas, patients were diagnosed with secondaryhyperparathyroidism if patient presented with renal failure, persistently high levels of PTH, as well as hypocalcemia. All patients with primary hyperparathyroidism underwentexcision for adenoma while patients with secondary hyperparathyroidism underwenttotal Para thyroidectomy and auto transplantation. Visual analogue scale was used toassess bone pain at presentation and 12 to 24 hours after procedure, and then six-weeks atfollow-up. Change in symptomatology was observed and compared between the twosets of patients. Results: A total of fourteen primary hyperparathyroidism cases were observed in ourcenter. 13 patients presented with bone pain and deformity, three of these patients were operated for renal stones, three patients had depressive symptoms. The calcium ranged from 12-15mg/dl with adenoma ranging from 1.0 cm to 4.0 cm.Three cases were diagnosed as secondary hyperparathyroidism, secondary to renal failure. Total Para thyroidectomy was done to remove all four parathyroid glands with subsequent auto transplant. All patients had hypo calcemic signs postoperative, which was relieved after calcium transfusion for two days followed by oral. Conclusion: In all patients, irrespective of the cause of the hyperparathyroidism, early pain reliefwas correlated with successful parathyroid surgery. Keywords: Parathyroid, hyperparathyroidism, primary, secondary, PTH, calcium, pain

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Early Bone Pain Relief a Reliable Indicator of Successful Para Thyroidectomy - A Comparative Prospective Study

Haider¹,

Ghansham²,

Mahmood³

et al. 2023

PJMHS

View full text Add to dashboard Cite

show abstract

“…Recurrent, progressive SHPT is caused by hyperthyroidism at the transplantation site or parathyroid tissue missed at first surgery, and it is very important to locate its source. For patients without a renal transplantation plan, the recurrence rate of total parathyroidectomy (tPTX) is lower than that of tPTX + AT (12). Although the onset and degree of hypocalcemia within six months after surgery are higher than those of tPTX + AT, tPTX produces better outcomes in the incidence of bone and mineral metabolism disorders (13,14) and bone density.…”

Section: Discussionmentioning

confidence: 99%

“…tPTX can reduce the level of iPTH, improve disorders of calcium and phosphorus metabolism, and relieve the clinical symptoms caused by a series of lesions in the skin, soft tissue, bone, and blood vessels. It can also even improve sleep quality, mental health, behavioral health, quality of life, and social function (12,15). There are two major benefits to the use of tPTX over other methods.…”

Section: Discussionmentioning

confidence: 99%

Application of nanocarbon negative imaging technology in surgery for secondary hyperparathyroidism

Liu²,

Huang

et al. 2021

Gland Surg

View full text Add to dashboard Cite

show abstract

“…In a cohort study, Seehofer et al proposed to use iPTH 15min ≤150 pg/ml or iPTH 15min /iPTH pre ≤30% as the intraoperative predictive index [ 17 ]. Silveira et al reported an iPTH 10-15min decay ≥80% of the highest iPTH pre as a predictor of surgical success, showing an accuracy of 86%, a sensitivity of 88%, and specificity of 67% [ 18 ]. In a study by Hiramtsu et al [ 9 ] a >70% iPTH drop from the baseline to 10 min after PTX could effectively predict the surgical outcomes (sensitivity 97.5%, specificity 52.2%, accuracy 92.9%).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Intraoperative Intact Parathyroid Hormone Monitoring for Surgical Outcomes of Secondary Hyperparathyroidism

et al. 2021

View full text Add to dashboard Cite

Background Intraoperative intact parathyroid hormone (IO-iPTH) monitoring has not reached a consensus in predicting surgical outcomes of secondary hyperparathyroidism. Here, we explore the predictive effect of IO-iPTH monitoring on surgical outcomes of secondary hyperparathyroidism as a potentially effective standard. Material/Methods We enrolled 119 patients who underwent total parathyroidectomy with autotransplantation from January 2016 to August 2019. Intact parathyroid hormone (iPTH) levels were tested 1 day before surgery (iPTH pre ), 10 min after glands resection (iPTH 10min ), and 1 and 7 days after the operation (iPTH d1 , iPTH d7 ). According to iPTH pre levels, patients were divided into a <2000 pg/ml group and a ≥2000 pg/ml group, and the cutoff values were compared. In patients with successful parathyroidectomy, the value of iPTH pre minus iPTH 10min (iPTH dec ) and relative-iPTH 10min were compared between groups. Results Using cutoff values, the predictive criterion was defined as iPTH 10min ≤314.5 pg/ml or relative-iPTH 10min ≤12.4%. In the iPTH pre ≥2000 pg/ml group, iPTH 10min had a higher predictive value (318 pg/ml vs 218 pg/ml) whereas relative-iPTH 10min had a lower predictive value (12.1% vs 20.3%). In patients with successful PTX, the iPTH dec value of the iPTH pre ≥2000 pg/ml group was significantly higher than that of the <2000 pg/ml group. Additionally, the relative-iPTH 10min was significantly lower in the ≥2000 pg/ml group than in the <2000 pg/ml group. Conclusions An intraoperative predictive criterion of iPTH 10min ≤314.5 pg/ml or relative-iPTH 10min ≤12.4% is associated with effectively predicting surgical success of secondary hyperparathyroidism. The predictive value is affected by iPTH pre level; therefore, a variable prediction standard based on iPTH pre levels shall be established.

show abstract

Critical analysis of the intraoperative parathyroid hormone decrease during parathyroidectomy for secondary and tertiary hyperparathyroidism

Cited by 7 publications

References 39 publications

Early Bone Pain Relief a Reliable Indicator of Successful Para Thyroidectomy - A Comparative Prospective Study

Early Bone Pain Relief a Reliable Indicator of Successful Para Thyroidectomy - A Comparative Prospective Study

Application of nanocarbon negative imaging technology in surgery for secondary hyperparathyroidism

Diagnostic Accuracy of Intraoperative Intact Parathyroid Hormone Monitoring for Surgical Outcomes of Secondary Hyperparathyroidism

Contact Info

Product

Resources

About